Two acute dangers threaten the life of persons suffering from chronic peptic ulcer: the perforation of the ulcer into the peritoneal cavity, and fatal hemorrhage from eroded blood vessels. Fatal hemorrhages are comparatively rare events in chronic gastric ulcers. Da Costa1 reports that only 3 to 8 per cent, of persons actually die of hemorrhage. The spread of an ulcer sometimes, though not as often as it is generally considered, causes obstruction of the blood vessels in its base by inflammatory changes in the vessel walls and by thrombosis. In this way larger hemorrhages may be prevented. But, on the other hand, the contractibility of a blood vessel embedded in the firm, cicatrized tissue of the ulcer may be impaired and so increase the possibility of abundant bleeding from smaller vessels.
My own experience is based on fifty-five cases in which the patients have died from peptic ulcer of